Complementary Therapies in Medicine
Volume 38, June 2018, Pages 67-73
Treatment of intradialytic hypotension with an herbal acupoint therapy in hemodialysis patients: A randomized pilot study
Ming-YenTsai, Chien-Hsing Wu, Yu-Chuen Huang, Shih-Yu Chen, Hwee-Yeong Ng, Yu-Jen Su, Yung-Hsiang Chen
(authors from various institutions in Taiwan)
Abstract
Objective:
Hypotension during hemodialysis (HD) is the most common complication that negatively affects the quality of life of patients. The objective of the current study was to evaluate the preliminary efficacy and safety of herbal acupoint therapy (HAT) for intradialytic hypotension (IDH).
Methods:
A randomized, placebo-controlled trial was performed in 32 HD patients to determine whether HAT was more effective than a sham treatment for the treatment of IDH. The outcomes were frequency of IDH episodes and number of nursing interventions during HD sessions, pre- and post-dialysis BP, subjective change in fatigue as measured by the Visual Analogue Scale (VAS), and recovery time from fatigue after dialysis at the 0th and 4th week. Data analyses were performed using per-protocol population.
Results:
In all, 27 patients (84%) completed the entire study. At the end of the intervention, the patients in the HAT group were found to have a significantly lower frequency of IDH episodes, fewer nursing interventions, a lower intervention failure rate, and earlier discontinuation of dialysis than those in the sham group (p<.05). The improvement in degree of fatigue (p=.001) was greater and recovery time from fatigue after dialysis (p=.03) was shorter in the group treated with HAT than in the sham group. HAT was safe, with 2 withdrawal cases due to local erythema caused by the patch.
Conclusions:
HAT appears to be safe and efficacious for improving IDH-related symptoms and intervention in HD patients. Larger studies are needed to confirm the benefit of this technique for IDH.
https://www.sciencedirect.com/science/article/pii/S0965229918301006Excerpts:
"Traditional Chinese medicine (TCM) influences multiple mechanisms in the human body. With regard to HD patients, the moxibustion (burning of moxa directly or indirectly at the acupoints) has been found to alleviate fatigue, depression, sleep disturbance, and uremic pruritus.10 Moxibustion can dredge meridians and regulate qi-blood, and it has been used to prevent and treat diseases, especially in cold-deficiency syndrome.11 However, shortcomings of traditional moxibustion such as air pollution and potential burning of the skin limit its application.12
"Another TCM modality is herbal acupoint therapy (HAT), one type of moxibustion therapy. HAT is applied to the acupoint with an herb patch that provides a constant irritant to the skin until the presentation of hyperemia, blistering, or even pustules. The synergistic effects of Chinese herbs and local acupoints achieve the goal of strengthening Yang-qi, removing cold pathogens, enhancing immunity and harmonizing Yin and Yan. Clinical research has found that herbal acupoint therapy is efficacious in the treatment of airway inflammation.13 HAT for allergic rhinitis and asthma can improve self-reported health and social function, and it can also reduce the frequency of use of western medicine.14, 15, 16 Therefore, HAT is a convenient, noninvasive technology that is worth developing and provides self-regulation within treatment parameters.
"According to TCM theory, symptomatic IDH is caused by the disequilibrium of qi-blood and subsequent exhaustion of Yang-qi in the human body during the rapid fluid removal of HD. If a proper HAT protocol is developed to alleviate IDH episodes effectively for dialysis patients, the quality of life and control of the hemodynamic stability of the patient could be improved. However, few researchers have examined HAT practices in IDH. Thus, more evidence is needed to validate the effects of HAT on IDH."
"The patches were applied 10 min before each session, and at the end of the HD, they were removed and the surrounding skin was checked. The patches were placed on 3 points—the KI1 (bilateral) and CV4 acupoints—and each acupoint was covered with gauze with a non-woven adhesive plaster for 4 h (Fig. 1). The real and sham HAT patches were identical in appearance (diameter 2.0 cm, depth 0.5 cm), but the sham patches were made with brown clay. Each patient received treatments in their regular HD sessions (3 times per week for a total of 4 weeks) for a total of 12 sessions. Only the patch operator was informed of whether the HAT was real or not."
"In general, HAT can regulate body function and strengthen the self-healing capacity through the pharmacological action of herbal medicines and their stimulation of acupoints. Local irritation caused by herbal patches not only makes it easier for the body to absorb the medicinal substances through the skin but also enhances the stimulation of specific acupoints.22 Therefore, the commonly-used drugs for HAT modulation are warm in nature, some examples being Cortex Cinnamomi, Syzygium Aromaticum, Fructus Psoraleae, Zanthoxylum bungeanum, or Sinapis Semen.23 The main herbal patches used in this study were adapted from the Sinapis Semen and Corydalis Rhizom plastering method for treating obstinate cold syndrome, as described in Zhang Shi Yi Tong. Sinapis Semen has the effects of expelling phlegm, warming Yang-qi, and promoting blood stasis. Corydalis Rhizom also promotes circulation of qi-blood and alleviates pain; its vasodilation effect is excellent. Corydalis Rhizom is able to strengthen the effect of Sinapis Semen and reduce its irritating harm to the skin.24?A recent article from Liao et al. that analyzed 467 chronic HD patients found that the major constitution was Yang deficiency (43.7%).25 Chen et al. reported in 2007 that HD patients with Yang deficiency of the spleen and kidney and deficiencies of Yin and Yang tend to be older and have longer dialytic periods, intelligence impairment, malnutrition, and debility.26 This pattern suggests the rational application of HAT to HD patients based on the ability of HAT to boost Yang-qi."
"The acupoints CV4 and KI1 are commonly used for treating asthenic diseases related to the spleen, kidney, and heart. CV4 belongs to the Conception Vessel and has connections with 3 Ying meridians as well as internal organs, according to TCM theory. Many previous studies have showed CV4 to have benign regulative effects on certain deficiency conditions in illnesses.28, 29 KI1 has the functions of opening the sensory orifices, recovering from unconsciousness, discharging heat, stimulating the blood pressure, and restoring Yang to prevent collapse.30"
"Another possible explanation for the therapeutic effect of HAT resembles the concept of transdermal drug delivery systems.31 The skin barrier function is weak, and blood vessels and nerves are abundant around the specific acupoints, which make them highly sensitive locations with faster absorption rates of drugs.32, 33 For HAT, persistent thermal stimulation of the acupoints also contributes to the therapeutic actions, and therein lies one of the distinctive differences between meridian and anatomical findings. Regulation is considered to be a comprehensive promoting effect involving multiple systems of the body."
"It is still controversial whether HAT-induced skin reactions benefit or harm the patient; after all, some TCM doctors still believe that as the scar develops, the symptoms will lessen. 34"
The mechanism of the effects of HAT on IDH in dialysis patients has not been fully studied. It has been postulated that HAT may activate the areas of the brain correlated with perception,44 or stimulate the release of adrenergic neurotransmitters, cytokines, and inflammatory factors.32, 45 The findings suggest that HAT may have potential in ANS modulation of intradialytic tolerance in hypotension, similar to balance the Yin and Yang."
"Some limitations are noted in the present study. First, this study had only 27 participants, which may not have been a sufficiently large enough sample size, especially for statistical evaluation of the data."
"Third, the operator knew the type of HAT each patient received but was blinded to the grouping numbers of the patients and outcome assessments. Therefore, the findings of our study are unlikely to have been influenced by the bias introduced by knowing that an individual is randomized to an active group."
